Skin conditions quiz Flashcards
What is the most common form of skin cancer but least malignant?
basal cell carcinoma - rodent ulcer - basal cells overproliferate
Cured in >99% of cases
How does basal cell carcinoma arise and treat
in later life due to sun exposed areas. - present as shiny dome shape nodules but not fluid filled. - spider blood vessels veins
Slow growing
surgery, radiotherapy, cryotherapy (FU, imiquimod)
What is. squamous cell carcinoma
arises from keratinocytes of the squamous epithelium
Scaly red papules that ulcerate & bleed and they can arise on head, scalp, hands
Rapid growing and metastases
If caught early - surgery/radiotherapy
what is the most dangerous of all skin cancers and prevalence in terms of all cancers?
Malignant melanoma
5% of all cancers
Where does melanoma occur?
Areas of exposed skin due to sun exposure, or positive family history
men more common in head, face, hands, back
Women more common in lower leg
What % of melanomas arise from pre-existing moles?
30%
What is the pharmacist role in melanoma?
Giving. advice e.g. sun protection, avoiding sun exposure between 10-3pm
Sun hat
Sunscreen with at least SPF30
apply regularly and use a high SPF and UVA rating
- recognise melanoma etc
- do not diagnose or recommend therapy/reassurance/referral to GP
what is the ABCDE acronym to recognising melanoma?
american
A - asymmetry - one half doesn’t match
B - border - irregular, ragged, notched, blurred
C - colour - pigmentation not the same e.g. black, brown, red, white, blue, mottled appearance
D - diameter>6mm but any growth evaluate
E - elevation
According to the glasgow 7 point checklist for melanoma - what are the major criteria and minor?
MAJOR (3)–> change in: size, shape, colour
Minor–> diameter >6mm, inflammation, bleed/ooze, mild. itch/altered sensation
What drug is better for athletes foot than imidazoles?
Terbinafine
How would you treat localised tinea?
Topical broad spectrum cream - imidazoles e.g. clotrimazole, miconazole, terbinafine TDS for 1-2 weeks
Note that if it is on the SC then the skin will regenerate and shed off the fungi and resolve alone. But if deeper then it will not resolve without treatment.
How would you treat widespread tinea?
Oral terbinafine 250mg OD Itraconazole 100mg OD 1-2 months Not licensed in children Oral griseofulvin for tinea capitis
what is tinea incognito?
Tinea fungal infection modified by steroid treatment
How is tinea spread?
Direct contact
pools, sharing towels
Most common type of eczema
Atopic = dermatitis
What is atopic eczema
Genetic predisposition to allergic hypersensitivity - IgE produces dry, scaly, erythematous and itchy rash that is noticeable on face, scalp, neck, inside elbows, behind knee
what % of children who have atopic dermatitis go on. to develop asthma and. hayfever?
> 50% go on to develop asthma
>75% go on to. develop allergic rhinitis(hayfever)
What is atopic eczema a combination of?
SKin barrier damage
Genetics e.g. filaggrin (predisposition)
Triggers e.g. internal inflammation, soaps, environment
All lead to overproduction of a protease, break down corneodesmosomes, break epidermal cohesion & disrupt differentiation
What is irritant contact eczema and what is allergic contact eczema?
irritant contact is damage to skin from topically applied liquids or chemicals, no allergic mechanism
Allergic contact is where the patient is allergic to an allergen and whenever they are in contact with it they get a eczematous rash e.g. Nickel
How to treat eczema dermatitis? / atopic eczema
Let skin recover
Emollients / emulsifying ointment to maintain hydration of the stratum corneum and reduce water evaporation - this avoids dryness and cracking, increases water content - without SLS e.g. E45
- topical steroids 1% HC cream to reduce inflammation ; itch in a flare
- Sedating antihistamines e.g. chlorpheniramine piriton at night to help itch
- only use aqueous cream emollient if washing off
- Avoid soap, wool fabrics, synthetics as they dry skin/irritant (soap and aq cream contains SLS which is a harsh anionic surfactant).
What is the. problem with sodium lauryl sulfate?
Itchy
Reduces stratum. corneum thickness and increases transepidermal water loss, affects stratum corneum pH and enzyme activity/NMF - stops regulation of the barrier
Advice for seborrhoeic eczema
Reduce exposure to allergens.
Keep cool, loose cotton, avoid wool
Soap free cleanser
Regular. antifungal use
What is systemic lupus erythematosus characterised by?
What drugs increase risk?
Butterfly rash on cheeks and. nose. - exacerbated by sunlight/stresses that increase skin circulation, it is autoimmune
Phenytoin, beta blockers, lithium, sulfasalazine, penicillamine
What is psoriasis?
Chronic autoimmune disorder - person has a. genetic predisposition but need other triggers. It is a chronic scaling disease causing skin redness/inflammation, with raised, rough, reddened lesions with fine silvery scales
appearing on back of elbows, flexor surfaces, sometimes scalp.
Due to increased epidermal cell differentiation (10x faster) hyperproliferation of basal cells - come to surface too quickly causing the silvery plaques
What are the triggers of psoriasis
- Infection - throat and upper Resp tract infection can lower the threshold
- Trauma e.g. surgical incisions, rubbing, burns, scratch, sunburn, picking
- Stress, anxiety
- Climate e.g. sunlight
- Drugs–> Lithium, ACEi, NSAIDS, beta blockers, alcohol abuse
- immunological assault
What are the types of psoriasis?
Plaque most common 90% - scattered raised scaly patches on elbows, knees, scalp - itchy, sore, silvery
Guttate - (teardrop shape) patches all over body - common in young and may follow throat infection. can spontaneously. resolve
Flexural (inverse)- on areas of skin-to-skin contact e.g. armpits, groin, buttocks = later life
Generalised pustular = acute severe eruption of pustules, red skin and high fever - can be due to large amount of steroid creams. Not v common
pustular- chronic, on hands and feet, middle age
Psoriatic. arthritis - inflammatory joint. disease - skin change before pain
Treatment aims in psoriasis
Control/management not a cure - aim to reach a point where they can tolerate symptoms and can occur every 3. months in cycles
- not itchy, painful, looks better
Key treatments in psoriasis
Emollients hydrate skin/anti-proliferative
Topical CCS - inflammation. Mild for face/flexures, strong for scalp, hands, feet (betamethasone)
Calcipotriol (dovonex) - synthetic vitD3 analogue interferes with cell division and differentiation
(mildest effective treatment shortest time).
Other
- Dithranol - good to induce remission, irritates normal skin, not widespread/face/flexures.
- Coal tar anti-inflammatory and anti-scaling but messy
- salicylic acid keratolytic for scalp
- Retinoids mild to moderate affecting 10% of skin, tazarotene 0.05%
What are comedones?
Papules?
Nodules?
cysts?
Blackheads (open), whiteheads (closed)
papules are pinheads - elevation of skin, no fluid 5-10mm
Nodules are bigger than 5-10mm but papule like
Cysts are fluid fulled cavities
Common places of acne
Face, shoulders, trunk, arms, legs
How is acne formed?
When hair follicles & sebaceous gland become obstructed with sebum/dead keratinocytes. (usually due to increased androgens producing. more sebum and thys hyperproliferation of keratinocytes). Can become infected with normal skin anaerobe p.acnes leading to inflammation. Lipases from p.acnes metabolise triglycerides into FFA which irritate the follicular wall and then result in inflammation in the follicle, causing pustules/pus.
When the inflamed follicles rupture, it causes nodules & cysts
Treatment of acne
main aim to reduce sebum production, comedone formation, inflammation & infection.
Cleanse affected areas daily but no need for extra washing, scrubbing,or antibacterial soaps (no added benefit as within the gland).
Managing expectations will not work straight away
usually improves with age
Not using occlusive make up
No need for changes in diet
Mild-moderate topical
Moderate-severe systemic abs
How does benzoyl. peroxide work for acne?
Peroxide is metabolised to benzoic acid and oxygen free radicals, benzoic acid reduces pH and the O2 free radicals are bactericidal and break down keratin so are comedolytic.
What is an alternative to benzoyl peroxide if irritation / sensitive / face?
Azelaic acid - anti-microbial and anti-comedomal but less likely to cause irritation
What is rosacea?
Inflammatory skin disease affecting middle third of the face, occurs in adults age 30-60 and fair skin, no blackheads/whiteheads.
- redness over face/nose that blush, dilation of blood vessels
- cyclical
Triggers/causes of rosacea
Unknown - genetic and environment Blush easily Emotion, stress, embarassment changes in weather. - wind, humid, sun H.pylori vasodilators, CCS spicy food, coffee, alcohol.
Treatment of rosacea
Topical metronidazole (little effect on vascular component) - mainly just reduce inflammatory papules
Topical azelaic acid for redness
oral tetracycline
Advice for rosacea
Sunscreen spf>30
Protect face in winter e.g. scarf
Avoid skin irritants and products containing alcohol
when using a moisturiser with topical meds - apply the moisturiser after the medicine has dried
Use products that are ‘non-comedogenic’ so will not clog pores
Avoid alcohol
Don’t touch/rub area
Ideal characteristics for a wound dressing
Maintain moist environment Manage excess exudate allow oxygenation provide a barrier to microorganisms maintain a warm environment not shed particles/fibres eliminate odour cost effective acceptable for the patient non irritating
If someone has very severe psoriasis?
Oral - retinoids
- methotrexate
- ciclosporin
- mABs /biologics
What is the pharmacists role in psoriasis?
Recognising it
Reassurance and support, telling them it is recurring and many will be aware.
Mild - reassurance and emollient
If otherwise - refer to GP
What are acne triggers?
Hormones puberty pregnancy make up (occlusive) excessive humidity/sweating stress drugs e.g. steroids - under steroidal control
Side effects of isotretinoin
Sun sensitivity /photophobia dry skin teratogenicity CV problems as increases lipids Depression
What can be used to treat scabies?
Permethrin
ivermectin
What is the characteristic symptom of impetigo?
Honey coloured crusts on face
When providing benzoyl peroxide what should you advise to patient?
Can cause some irritation but will subside
may not work straight away and keep using to work - managing expectations
Can stain clothes.
Will start at low dose and increase up by concentrations
2.5, 5, 10%
WHAT ARE SOME drugs that can cause phototoxicity
TCAs retinoids tetracyclines methotrexate trimethoprim / sulfonamides furosemide thiazide diuretics quinolones Perfumes coal tar
Does phototoxicity require prior sun exposure?
No
If you have a wound that has healed why is it not as strong as the original skin?
Collagen is not as strong because initially it gets laid down quickly and does not have time to organise.
What type of allergy is photoallergy?
Type 4 inappropriate T cell activation. Need prior exposure
What is a sloughy wound?
Yellow. cellular debris, fibrin, exudate, bacteria
What is a granulating wound?
Vascularised pink/red wound
What is an epithelialising wound?
Pink wound bed, cells migrating from wound edge to start re-epithelialisation
What is the typical acne scar called?
Atrophic scar -sunken, pitted
What can alginate dressings be used for?
Wet or cavity wounds
Calcium or sodium salts - absorbent
